Objectives: Nuclear medicine has changed rapidly as a result of technological developments. Very little is reported on the effects these developments may have on technologist productivity. This study aims to determine whether advances have created a workplace where more patient studies can be performed with fewer technologists. The level of change in automation or time taken to perform a routine task by the nuclear medicine technologist as a result of technological development over the past decade is reported.

Methods: A systematic review was conducted using Embase.com, Medline, INSPEC, and Cinahl. Two authors reviewed each article for eligibility. Technological developments in routine areas over the past decade were reviewed. The resultant automation or time effects on data acquisition, data processing, and image processing were summarized.

Results: Sixteen articles were included in the areas of myocardial perfusion, information technology, and positron emission tomography (PET). Gamma camera design has halved the acquisition time for myocardial perfusion studies, automated analysis requires little manual intervention and information technologies and filmless departments are more efficient. Developments in PET have reduced acquisition to almost one-fifth of the time.

Conclusions: Substantial efficiencies have occurred over the decade thereby increasing productivity, but whether staffing levels are appropriate for safe, high quality practice is unclear. Future staffing adequacy is of concern given the anticipated increasing service needs.

Objective: The aim of this study was to assess the incremental cost-effectiveness of on-demand versus prophylactic hemophilia therapy in Iran from a third-party payers’ perspective.

Methods: A retrospective chart review of twenty-five type A hemophiliacs who were treated in three hemophilia treatment centers was conducted. The patients were boys 0–9 years old receiving one of two treatments: (i) prophylaxis with concentrate at clinic; (ii) concentrate at clinic as on-demand. Fourteen boys received on-demand infusions for bleeding events, and eleven boys received infusions prophylaxis. Data were extracted from documents in the hemophilia treatment centers during a period of approximately 6 months.

Results: The patients receiving prophylactic treatment had fewer bleeding events each month (mean, 0.26 versus 2.74) but used more concentrate (225.31 versus 87.20 units/kg per month). Average monthly cost per patient in the prophylaxis group was approximately 1.9 times higher than in the on-demand group. Compared with on-demand infusion, prophylaxis costs 3,201,656 Rials (€213.45) per bleeding event prevented.

Conclusion: Prophylactic care markedly reduces the number of bleeding episodes, but at considerable cost.

Objectives: This study explores several variables of the EQ-5D child version, a multi-attribute utility instrument, in children with chronic conditions.

Methods: A convenience sample was selected from hospital outpatient records and school records. The sample included children aged 7–18 years with the following chronic conditions: asthma, rheumatic disorders, diabetes, and speech/language and/or hearing disorders. The practicality, convergent validity, and discriminant power were compared with a generic quality of life questionnaire for children (TACQOL) and the 2-week test–retest reliability was assessed.

Results: A total of 182 children or their parents completed the first questionnaire and 161 children/parents completed both questionnaires. The practicality of the EQ-5D was good. Low to moderate correlations were found between the utilities and VAS scores and the TACQOL scales. The discriminant power of the EQ-5D items was low overall and was greater for children with a rheumatic disorder than for children with the other conditions. In the subset of children who experienced no health change between the test and the retest, the reliability of the EQ-5D was moderate to high.

Conclusions: The EQ-5D seems suitable for children, although the use of an additional disease-specific questionnaire is still recommended. The EQ-5D seems the most suitable for children with a chronic physical condition and appears to be reliable for children with a stable health status.

Objectives: This study aims to compare the impact of two different sources of resource use, self-report versus care provider registrations, on cost and cost utility.

Methods: Data were gathered for a cost-effectiveness study performed alongside a 2-year randomized controlled trial evaluating the effect of an INTERdisciplinary COMmunity-based management program (INTERCOM) for patients with chronic obstructive pulmonary disease (COPD). The program was offered by physiotherapists, dieticians and respiratory nurses. During the 2-year period, patients reported all resource use in a cost booklet. In addition, data on hospital admissions and outpatient visits, visits to the physiotherapist, dietician or respiratory nurse, diet nutrition, and outpatient medication were obtained from administrative records. The cost per quality-adjusted life-year (QALY) was calculated in two ways, using data from the cost booklet or registrations.

Results: In total, 175 patients were included in the study. Agreement between self-report and registrations was almost perfect for hospitalizations (rho = 0.93) and physiotherapist visits (rho = 0.86), but above 0.55, moderate, for all other types of care. The total cost difference between the registrations and the cost booklet was 464 euros with the highest difference for hospitalizations 386 euro. Based on the cost booklet the cost difference between the treatment group and usual care was 2,444 euros (95 percent confidence interval [CI], −819 to 5,950), which resulted in a cost-utility of 29,100 euro/QALY. For the registrations, the results were 2,498 euros (95 percent CI, −88 to 6,084) and 29,390 euro/QALY, respectively.

Conclusions: This study showed that the use of self-reported data or data from registrations effected within-group costs, but not between-group costs or the cost utility.

Objectives: To provide an overview of the development of health technology assessment (HTA) in Germany since the 1990s.

Methods: Analysis of key documents (e.g. literature, laws, and other official documentation) and personal experiences.

Results: Health technology assessment (HTA) entered the political agenda in Germany only in the mid-1990s, basically as the result of a top-down approach toward more efficiency in health care, but with a strong impetus of an evidence-based medicine movement. Accordingly, HTA became part of several healthcare reform laws since 1997, which led to the establishment of the Federal Joint Committee (G-BA) and the Institute for Quality and Efficiency in Health Care (IQWiG) in 2004. This tandem construction aims at using evidence in decision-making processes for coverage and other decisions.

Conclusions: These developments have led to a considerable impact of HTA in Germany. In addition, a broad spectrum of activities at universities and in other organizations, such as the German Institute for Medical Documentation and Information (DIMDI), can be observed that contribute to both teaching and research in HTA. German researchers in the field of HTA are actively involved in international projects, such as EUNetHTA, and contribute to scientific conferences and journals.

In Hungary, the history of the health technology assessment (HTA) dates back to 1993 when HTA and related activities started by professional initiatives. The legal background, institutionalization, and training capacities were created between 1998 and 2004. The main challenges for HTA in Hungary are partly similar to the ones in countries with a developed economy; no question it is time for cost-effectiveness. However, there are very important differences as well, that is why transferability and adaptability issues have to be considered. This article describes the characteristic features of the Hungarian healthcare system, the history and the current role of HTA, and the most important challenges.

Objectives: The Weight Loss Maintenance Trial (WLM) was a multicenter, randomized trial comparing two weight loss maintenance interventions, a personal contact (PC) program with primarily telephone-based monthly contacts, and an Internet-based program (interactive technology, IT), to a self-directed control group, among overweight or obese individuals at high cardiovascular risk. This study describes implementation costs of both interventions as well as IT development costs.

Methods: Resources were micro-costed in 2006 dollars from the primary perspective of a sponsoring healthcare system considering adopting an extant intervention, rather than developing its own. Costs were discounted at 3 percent annually. Length of trial participation was 30 months (randomization during February–November 2004). IT development costs were assessed over 36 months. Univariate and multivariate, including probabilistic, sensitivity analyses were performed.

Results: Total discounted IT development costs over 36 months were $839,949 ($2,414 per IT participant). Discounted 30-month implementation costs for 342 PC participants were $537,242 ($1,571 per participant), and for 348 IT participants, were $214,879 ($617 per participant). Under all plausible scenarios, PC implementation costs exceeded IT implementation costs.

Conclusions: Costs of implementing and operating an Internet-based intervention for weight loss maintenance were substantially less than analogous costs of an intervention using standard phone and in-person contacts and are of a magnitude that would be attractive to many health systems, subject to demonstration of cost-effectiveness.

Once upon a time in the 1990s, if you wanted to do HTA in the Central and Eastern European countries (CEEs), you got yourself invited by Egon Jonsson and travelled to Stockholm to learn how to do HTA. There you met him and Prof. Banta and other HTA professionals from all over the world—very importantly, motivated healthcare professionals from all CEEs who were eager to learn HTA. These eminent founding fathers were always available, and were never tired if help or assistance was needed. During that time, the telephone number of HTA was known and used extensively, making it a real, living, informal HTA network. Formal HTA collaborations organized by them and funded by the European Commission, such as EUR-ASSESS, HTA EUROPE, ECHTA/ECAHI, were also crucial . . .

Objectives: The aim of this study was to review the history of health technology assessment (HTA) in Italy.

Methods: Founded in 1978, the Italian National Health Service (NHS) has been strongly regionalized mainly after a constitutional reform, which started a devolution process. HTA started in the 1980s at the National Institute of Health and in a few University Hospitals, with a focus on big ticket technology: that process was driven by clinical engineers.

Results: In recent years, HTA is becoming an important tool for decision-making processes at central, regional, and local levels. In particular, the National Agency for Regional Health Services (AGENAS) and five regions (of twenty-one) are strongly committed to develop HTA initiatives connected with the planning process.

Conclusions: At the local level, the hospital-based HTA activity is probably the most important peculiarity of the country and the real driver of the HTA movement.

Objectives: The aim of this study is to perform a comparative costs analysis of brachytherapy (BT) and radical retropubic prostatectomy (RRP) for clinically localized prostate cancer and to shed light on the difficulties of comparing their relative economic effectiveness.

Methods: A systematic literature review of costing studies available in the Medline, Embase, DARE, and INAHTA databases.

Results: There is a lack of homogeneity among published studies in this field. Differences in the reported costs are related to different environments in which the two techniques (BT and RRP) are applied, and in particular due to the use of different methodology, cost items included, time frames, and different price levels in different settings.

Conclusion: Published studies of costing data of BT and RRP do not provide clear-cut evidence for a conclusion about which treatment may be more effective from an economic point of view.

Objectives: The aim of this study was to describe the history and present situation with health technology assessment (HTA) in Israel.

Methods: The method used in this study was a historical analysis based mainly on the knowledge of the authors, but supplemented by the published literature.

Results: HTA originated in Israel as a centralized function conducted under the auspice of research, developing into an active multidisciplinary center. Throughout the expansion of the field, HTA was performed in affiliation with several local and international bodies, while providing direct and indirect support at the national level. Today, mainly as a result of vigorous dissemination of the principles, methodology and tools for HTA by the Israeli Center for Technology Assessment in Health Care (ICTAHC), this discipline is increasingly a decentralized activity conducted by a great variety of institutions. Israeli health policy decisions are increasingly based on the results of HTA.

Conclusions: ICTAHC's role and functioning has expanded since its beginnings. HTA has become an important part of health care in Israel.

Objectives: The aim of this study was to obtain information on rapid health technology assessments (HTAs) prepared by members of the International Network of Agencies for Health Technology Assessment (INAHTA).

Methods: A questionnaire was prepared, drawing on earlier INAHTA documents for recording HTA impact. A request for responses was sent to member agencies, seeking information on rapid HTA reports prepared during 2006.

Results: Responses were provided on fifteen rapid HTAs, which covered both new and widely distributed technologies. The most common purpose for the HTAs (n = 8) was to inform coverage decisions, but other reasons included capital funding, formulary decisions, referral for treatment, program operation, guideline formulation, influence on routine practice, and indications for further research. All the rapid HTAs were considered by the agencies to have had some influence. The most common indications of influence were consideration by the decision maker, use of the HTA as reference material (both n = 10), and acceptance of recommendations or conclusions (n = 8).

Conclusions: Rapid HTAs are used for a broad range of technologies, to inform several types of decision, and are effective in informing the decision-making process. Supplementation of their findings by further assessments will be appropriate in some cases.

Objectives: The aim of this study was to assess the trends and costs of statin use in Lithuania over a 3-year period and perform a cost-minimization and reference price analysis to rationalize the use of financial resources of the National Health Care System.

Methods: The defined daily dose (DDD) methodology was applied for assessment of statin use, which was expressed in DDD/1,000 inhabitants/day. Cost minimization and reference price calculations were used in the economic analysis.

Results: Over the 3-year period (2005–2007), the consumption and expenditures of statins in Lithuania doubled. The consumption went up from 3.87 DDD/1,000 inhabitants/day (in 2005) to 8.35 DDD/1,000 inhabitants/day (in 2007). Total expenses of statins increased during the same period from LTL6.186 million in 2005 to LTL12.418 million in 2007. Approximately 68 percent of the estimated costs for statins in 2007 were for atorvastatin. Provided that the calculated reference prices were fixed, the estimated savings would amount to a minimum of LTL1.371 million per year and could reach yearly savings in the order of LTL3.163 million. The total expenses would drop by at least 11 percent, and the decrease in costs could be as high as 25 percent (€1 = LTL3.4528).

Conclusions: Statins consumption is still very low in Lithuania in comparison with other European Union countries. Implementation of cholesterol education programs and changing reimbursement profile for statins therapy will increase consumption and expenditures. The introduction of reference-based pricing as an indirect cost control policy would help rationalizing the use of statins and their expenditures.

Objectives: To describe how Lithuania is attempting to develop health technology assessment (HTA) structures.

Methods: The case study of the history of development of HTA in Lithuania is presented.

Results: Historical steps of HTA development are as follows: in 1993, a few conferences on HTA; eight people were trained in Sweden at SBU; the book First Steps of HTA in Lithuania (5) was issued together with SBU in 1993; participation in the International Society of Technology Assessment in Health Care (ISTAHC) conferences; participation in development of training courses and European networks of HTA; new people in HTA were trained in health accreditation service, Sickness Fund, and Ministry of Health. The major step was establishment of an evidence-based medicine library.

In 1994, Article 54 in the Health Care System Law, which declares that the use of healthcare technologies that have not been assessed or approved shall be prohibited, except in cases provided by law, was passed. The procedure of healthcare technologies assessment and approval was to be established by the Ministry of Health Care. A policy of HTA was approved with the program for HTA in 1999 in the Ministry of Health. Currently, enthusiasts of HTA fully realize that technology assessment is a developing frontier for creative and constructive thinking from all disciplinary view points.

Conclusions: Unfortunately, in this country, there is still a very small demand for HTA reports from the decision-maker's side. Hopefully joining the network of European Union Network for Health Technology Assessment (EUnetHTA) will give a new challenge for further policy development.

KDTD (Turkish Evidence-Based Medicine Association) hosted a conference on the subject of health technology assessment (HTA)-emerging countries in Ankara, Turkey on March 4–6, 2009.

Objective: The aim of this report was to describe the history of health technology assessment (HTA) in the Netherlands.

Methods: This article is a descriptive review from two people who have been very much involved in the events described and is based on review of relevant policy documents and Web sites.

Results: HTA has been progressively developed in the Netherlands since (at least) the early 1980s. Beginning in 1985, there were progressive attempts to expand and institutionalized HTA in the Netherlands healthcare system. These attempts were generally successful, but did not result in a national agency for HTA. An important development in HTA in the Netherlands was a special fund (Ontwikkelingsgeneeskunde) designed to support prospective HTAs with the main purpose of affecting insurance coverage decisions. The administration of this fund moved progressively to broaden the subjects chosen for analysis to include such subjects as chronic illness and disability. A more-or-less hidden conflict developed in the question of the leadership and orientation of this fund, with the result that it was largely moved to a more research-oriented and less policy-oriented site.

Conclusions: The situation today is that HTA is visible and is used by the government in policy decisions, especially in the areas of prevention and screening. In addition, HTA is influential in insurance coverage decision making, especially in the field of pharmaceuticals. The principles of HTA and evidence-based medicine are generally familiar to physicians and other clinicians, however, the influence of HTA on clinical and administrative decisions is less than in some other countries.